Overcoming Pain

Why people experience chronic pain, and the power they have to de-intensify it

Winding Down the Wars and Those Who Fought Them

Combat veterans are seeking relief from physical and psychological pain.

The wars are winding down, and veterans are returning home with both mental and physical health conditions. Posttraumatic stress disorder (PTSD) has been the most prevalent mental health disorder among veterans of both the Afghanistan and Iraq wars seen at the Veterans Affairs medical centers. Comorbid pain has accompanied this preponderance of PTSD.

Unfortunately, these young veterans with pain and PTSD are at high risk of prescription opioid misuse when one considers the high degree of substance abuse among veterans with PTSD. An article published earlier this year in the Journal of the American Medical Association examined the effect of mental health disorders, including PTSD, on the patterns of opioid prescription, the risks associated with such prescribing, and the impact of opioids on a more personal level.

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Indeed, those Iraq and Afghanistan war veterans with PTSD exhibited higher-risk opioid use, and outcomes such as injuries and overdose. Interestingly, the authors found that veterans with drug and alcohol use disorders were more likely to be prescribed opioids than veterans with no mental health conditions; this was more pronounced among those with a PTSD diagnosis. And veterans with PTSD were at a higher risk of being prescribed more than one opioid simultaneously, and sedatives with the opioids. Unfortunately, the concomitant use of sedatives and opioids results in a higher incidence of overdose.

The increased opioid prescriptions, higher-risk opioid use, and increased negative outcomes associated with opioid use in veterans with pain and mental health diagnoses, including PTSD, support the need to improve care of patients with pain and PTSD. A heightened risk of opioid and other substance abuse in veterans with PTSD only causes further deterioration in the ability of veterans to function in the workplace and in other social settings. When one considers the numerous studies demonstrating questionable benefit of opioids for chronic noncancer pain, the harms from the upsurge of opioid prescribing become even more concerning.

Combat veterans are seeking relief from physical and psychological pain. Caution should be exercised when prescribing opioids to help these young heroes. It is incumbent upon the caregiver to target both mental health disorders and pain on a simultaneous basis. Hopefully, this in and of itself will spur researchers and caregivers to look towards other treatment options besides that found in the form of a pill.

Mark Borigini, M.D., is a board-certified rheumatologist who has devoted his career to treating illnesses that cause chronic pain and disability.

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